Provider Demographics
NPI:1427019843
Name:SASSE, MARK F (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:F
Last Name:SASSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3686 GRANDVIEW PKWY STE 720
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-3408
Mailing Address - Country:US
Mailing Address - Phone:059-717-5002
Mailing Address - Fax:
Practice Address - Street 1:3680 GRANDVIEW PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3411
Practice Address - Country:US
Practice Address - Phone:205-971-7500
Practice Address - Fax:205-971-7572
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48228207RC0000X
AL31616207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00358331Medicaid
AL138658Medicaid
P01068510OtherRAILROAD/TRAVELERS
AL51125172OtherBCBS
AL51125172OtherBCBS
P01068510OtherRAILROAD/TRAVELERS